title: Airtightness of lung parenchyma without a closing suture after atypical resection using the Nd:YAG Laser LIMAX 120.
abstract: OBJECTIVE
  Lung metastases can be non-anatomically resected with a Nd:YAG Laser. It is recommended that the resected lung surface be sealed by slowly resorbable sutures. However, the lung tissue may be restricted by the sutures once it is re-ventilated. Thus, it was analysed whether the lung parenchyma is airtight after laser resection without suturing the defect.
  
  
  METHODS
  The pulmonary artery of unimpaired paracardial lung lobes of freshly slaughtered pigs (mean weight 46 g) was cannulated and rinsed out via a hypotonic saline-heparin solution (5000 IE) until the perfusate was clear of body fluid. The lobular bronchus was connected to an airtight ventilation tube (Fa. VYGON 520 3.5 oral tube) and ventilated pressure-controlled (PEEP + 5 cm H₂O, P₁ = 20 cm H₂O, frequency = 10/min) via a respirator. All lobes were perfused with Ringer solution at 42°C at normothermia and normotonia. In group 1 (n = 8), an atypical peripheral parenchymal resection (average resected surface: 2 × 2 cm(2)) and in group 2 (n = 8), a deep atypical parenchymal resection (average resected surface: 4 × 4 cm(2)) were performed with the Nd:YAG Laser LIMAX 120 (output power at 100 watts). After post-resection ventilation of 15 min, the resection surface was tested for airtightness and burst pressure.
  
  
  RESULTS
  All group 1 lobes tested airtight under pressure-controlled ventilation. The mean burst pressure was 34.4 mbar (SD ± 3.2 mbar). Six lobes of group 2 were also completely airtight. The remaining two lobes, however, revealed a serious parenchymal leak (score 3). This was caused by the cross-opening of a segmental bronchus, although the surrounding lung parenchyma was also airtight. The mean burst pressure of these lobes was 31.7 mbar (SD ± 4.08 mbar). There was no significant difference between the two groups (P = 0.12).
  
  
  CONCLUSIONS
  Peripheral lung defects after Nd:YAG Laser resection might not be sutured, since the laser-induced vaporization of the lung parenchyma seems to be initially airtight. These experimental data warrant confirmation in a controlled clinical study.
authors.affiliation: Department of Visceral, Thoracic- and Vascular Surgery, Philipps University Marburg, Marburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kirschbaum
authors.forename: Thorsten
authors.initials: T
authors.lastname: Steinfeldt
authors.forename: Andreas
authors.initials: A
authors.lastname: Gockel
authors.forename: Pietro
authors.initials: P
authors.lastname: Di Fazio
authors.forename: Karl
authors.initials: K
authors.lastname: Quint
authors.forename: Detlef K
authors.initials: DK
authors.lastname: Bartsch
mesh_terms: D000818:Animals; D004867:Equipment Design; D053685:Laser Therapy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D053844:Lasers, Solid-State; D008168:Lung / Q000473:pathology / Q000601:surgery*; D008175:Lung Neoplasms / Q000556:secondary / Q000601:surgery*; D059146:Metastasectomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D023421:Models, Animal; D011013:Pneumonectomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D013536:Suture Techniques; D013552:Swine; D013997:Time Factors
keywords: Airtightness; Atypical lung parenchyma resection; Laser; Parenchyma closure